Prescription Advantage can help
By Margie Ware
At least twice a week, we at SHINE (Serving Health Information Needs of Elders) receive a call from someone sheepishly admitting they have been playing “prescription roulette,” but that they now need real Medicare Part D coverage. Can we help them?
What do I mean about “prescription roulette?” We don’t take the pills we don’t like or take only pills we get for $4 from the discount pharmacy.
But at least half the people who call would have qualified for Medicare Part D, and their entire monthly prescription cost would have been paid by the Commonwealth of Massachusetts through Prescription Advantage. But now that they have been diagnosed with diabetes, and really need Medicare Part D, yes they will be able to join, but unfortunately they will have to pay a late enrollment penalty for the rest of their lives.
In other cases, individuals calling are at an income level where they are responsible for the first $20 per month of their premium, or perhaps the entire premium. So, they have “saved” money for the last two years. Guess what? That insulin that they need, and will pay for out of pocket until they get a Medicare Part D plan, will cost them almost as much as they’ve “saved.” Additionally, it may have covered other medications they went without, because they didn’t want a drug plan. (Note: A key SHINE rule is we never, ever say “I told you so!” We just want to help.)
When these individuals call and want help, we can’t work miracles, but we can usually obtain prescription insurance for them within one to two months. How is that possible? Isn’t open enrollment in the fall? Don’t they have to wait until January 1 to get coverage?
Not if they join Prescription Advantage first. Thanks to a provision in the Medicare law that gives a “special enrollment period” for members of State Pharmaceutical Assistance Programs, and the foresight of the state Legislature, Massachusetts residents are eligible to join Prescription Advantage at any time during the year. If you qualify for a free membership, the only cost is the time it takes to gather your financial information and submit it to the program.
For individuals with higher incomes, there may be a $200 fee to join the program. However, because you’re getting access to a program that gives you the opportunity to access a 75% Federal contribution towards the first $2,500 of your prescription costs, you will more than save that $200 membership fee in the first couple of months.
Too many numbers! Too much to understand! Don’t worry, all you have to know is to call Elder Services SHINE program at 1-800-544-5242 or 499-0524 and we’ll do the remembering, thinking, sorting, analyzing and computer input.
Remember a great present for Mother’s Day is to make sure that your mom has the right prescription coverage. It costs nothing to ask a question. It can cost you a lot if you don’t ask.
Margie Ware is Elder Services’ Regional SHINE Program Coordinator.
